AB1312 HIGH PREVALENCE OF iRMD IN SARCOIDOSIS PATIENTS
Authors: S. Gulle, M. C. Ataca, G. Can, İ. Sari, M. Birlik, F. Onen
Journal: Annals of the Rheumatic Diseases (2022)

Background Sarcoidosis is a chronic granulomatous disease that primarily affects the lungs and lymph nodes, and can affect any organ and system (1). The incidence of concomitant iRMD is increased in patients with sarcoidosis. Anti-nuclear antibody (ANA) test are frequently used markers for inflammatory rheumatic diseases (iRMDs) (2). The relationship of this association with ANA is not clear. Objectives We aimed to determine the frequency of ANA in sarcoidosis patients and its possible correlation with clinical and laboratory data, and also to reveal the severity of osteoporosis in patients with sarcoidosis. Methods Ninety sarcoidosis patients, who were followed up in rheumatology clinic were included in this study. ANA were determined with indirect immunofluorescent method and 1/160 titration was accepted as positive. Demographic, clinical, serological, and bone mineral densitometry (BMD) results of all patients were recorded. BMD results were obtained from the images taken before the last date or osteoporotic fracture of the patients. Results Average age of the 90 patients (79 females) with sarcoidosis was 57.5 (IQR: 51–66) years, and median disease duration was 7.6 (IQR: 4-19) years. 28 (31.1%) patients had a diagnosis of extrapulmonary sarcoidosis (Most commonly skin, n=20, 71.4%). 21 patients had BMD values consistent with osteoporosis, while 9 patients had osteoporotic fractures. In 18 (20%) patients, rheumatologic autoimmune disease combined with sarcoidosis was found. SpA was diagnosed in 6 patients, RA in 2 patients, Lofgren Syndrome in 2 patients, SjS in 2 patients, systemic sclerosis in 1 patient, and morphea in 1 patient. Other rheumatological diseases were found as uBDH, polymyositis, Gout, Behçet’s Disease and FMF. ANA test was performed in a total of 83 patients. ANA positivity was found in 30 (36.1%) patients with sarcoidosis (1/100-1/320 in 12 patients; &gt;1/320 in 18 patients). There was no significant relationship between ANA positivity and gender distribution, age, disease duration, development of extrapulmonary sarcoidosis, refractory disease status, and laboratory findings at the time of diagnosis. It was found that ANA positivity at diagnosis time for sarcoidosis increased the risk of developing iRMD 4.8 times in patients [HR: 4.8, CI 95% (1.455-15.833), p=0.009]. Conclusion In sarcoidosis, ANA positivity is of great importance in the determination of accompanying iRMDs. It was found that ANA positivity at the time of diagnosis in sarcoidosis patients increased the risk of developing rheumatological autoimmune disease 4.8 fold. Since these patients receive long-term moderate-high-dose steroid-based treatments, they should be closely monitored and screened for osteoporosis. References [1]Wessendorf TE, et al. Clin Rev Allergy Immunol. 2015 Aug 18;49(1):54–62. [2]Kobak S, et al. Autoimmune Dis. 2014;2014:1–4. Table 1. Distribution of clinical features of patients with sarcoidosis according to ANA results ANA (-) (n=53 ) ANA (+) (n=30 ) n (% ) n (% ) p value Gender Female 46 (86.8) 27 (90) &gt;0.05 Male 7 (13.2) 3 (10) Rheumatic Disease No 48 (90.6) 20 (66.7) 0.009 (HR: 4.8, CI 95% (1.455-15.833)* Yes 5 (9.4) 10 (33.3) Refractory Disease No 35 (66) 19 (63.3) Yes 18 (34) 11 (9.1) BMD-DEXA Normal 16 (43.2) 12 (60) 0.630 Osteopenia 14 (37.8) 4 (20) Osteoporosis 7 (18.9) 4 (20) Osteoporotic Fracture No 46 (86.8) 28 (93.3) 0.477 Yes 7 (13.2) 2 (6.7) Median (IQR ) Median (IQR ) p value Age (year ) 56.5 (51/64) 58 (51/66) 0.836 Follow-up duration (year ) 6 (4/10) 6 (2/9) 0.718 Age at diagnosis (year ) 45.5 (38/55) 49 (36/55) 0.861 Calcium (mg/dL ) 9.585 (9.25/9.9) 9.4 (9.17/9.76) 0.138 25 (OH)D (pg/ml ) 15.5 (10.1/24) 8 (6/12) 0.005 Phosphorus (mg/dL ) 3.65 (3.245/3.98) 3.75 (3.3/4.1) 0.17 ACE (mcg/L ) 60 (32/87) 59.595 (34/88.225) 0.876 ESR (mm/h ) 23 (15/39) 29 (22/48) 0.171 CRP (mg/dL ) 4.8 (2.3/17) 5.4 (2.7/24) 0.343 *Multivariate regression analysis Disclosure of Interests None declared